Hypertension Clinic Research Articles

The Conundrum of Patients With Compensated Cirrhosis Requiring Kidney Transplantation; Kidney Alone or Simultaneous Liver Kidney Transplantation.

Patients with compensated cirrhosis and chronic kidney disease are increasing along with demand for simultaneous liver kidney transplant (SLKT) and shortages of organs for transplantation. Although these well-compensated patients may not need a liver organ, the alternative of kidney transplant alone (KTA) poses the risk of liver decompensation. Therefore, we aim to characterize outcomes among patients with compensated cirrhosis and chronic kidney disease listed for SLKT or receiving KTA to inform clinical decisions. The 2-part retrospective study included a national cohort of patients listed for SLKT in United Network for Organ Sharing from January 2003 to June 2019 with Child A cirrhosis, with model for end-stage liver disease <25, and receiving dialysis; and a cohort of patients who underwent KTA from 2004 to 2019 with Child A cirrhosis identified through a 4-center chart review. Waitlist outcomes (SLKT, death, and clinical improvement) and post-KTA liver decompensation and survival were evaluated in the cohorts, respectively. In the national SLKT cohort (N = 705, median age 56 y, 68.8% male), 5-y cumulative incidence of SLKT was 43.1%, death 32.1%, and clinical improvement 9.1%. Among SLKT recipients, 36.3% remained Child A without ascites or encephalopathy at transplant. In the local KTA cohort (N = 34, median age 54 y, 79.4% male), none had ascites or hepatic encephalopathy before KTA, but 15 had clinical portal hypertension. Five-y post-KTA incidence of liver decompensation was 36.8%, and survival was 89.2%. SLKT may not be necessary for some patients with compensated cirrhosis needing kidney transplant. KTA is safe for selected patients with intact liver biochemical function, even with portal hypertension but without hepatic encephalopathy or ascites.

Mildly elevated diastolic blood pressure increases subsequent risk of breast cancer in postmenopausal women in the Health Examinees-Gem study.

Epidemiological evidence suggests that hypertension is associated with breast cancer risk. However, previous studies disregard blood pressure components in the healthy population. We aimed to examine the relationship between systolic and diastolic blood pressure and breast cancer risk in a Korean population-based prospective cohort. A total of 73,031 women from the Health Examinees Gem Study were followed from baseline (2004 to 2013) through 2018. Systolic and diastolic blood pressure were measured by trainee physicians at baseline recruitment and then categorized based on the international guidelines for clinical hypertension. Associations between systolic and diastolic blood pressure with overall breast cancer and stratified by premenopausal and postmenopausal status were evaluated using adjusted multivariable Cox proportional hazard regression. A total of 858 breast cancer cases were recorded for a median follow-up period of 9 years. Compared with the normal DBP category (< 85 mmHg), the normal-high category was positively associated with breast cancer risk in postmenopausal women (85–89 mmHg, HR 1.73 95% CI 1.28–2.33), but not in premenopausal women (85–89 mmHg, HR 0.87 95% CI 0.56–1.35). Similar results were found when all cases of self-reported hypertension were excluded. Results for SBP did not show a significant association with breast cancer risk. The association between DBP and breast cancer suggests DBP could be an important factor in cancer prevention, especially for women after menopause. Our study provides a first detailed approach to understanding the importance of diastolic blood pressure for breast cancer prevention and warrants further investigation.

Silicone oil residual after vitrectomy for rhegmatogenous retinal detachment

ObjectiveTo explore the presence of residual emulsified silicone oil (SO) droplets in patients with rhegmatogenous retinal detachment (RRD) and their possible risk factors.MethodsPatients who underwent primary pars plana vitrectomy with SO injection for RRD and SO removal at the same eye centre were included. Approximately 10 weeks after SO removal, B-scan ultrasonography was performed, and using ImageJ, the silicone oil index (SOI) was measured, and its possible correlations with other clinical factors were explored.ResultsA total of 101 eyes were included. Residual SO particles were found in all the patients (100%), and the mean SOI was 4.04% ± 5.16% (range 0.06%–19.88%). Multiple linear regression revealed that, among all the clinical factors, axial length (AL) and ocular hypertension (intraocular pressure (IOP) > 21 mmHg or the use of antiglaucoma medications) before SO removal were positively and significantly associated with the SOI (all P < 0.05). Patients with ocular hypertension after SO removal had a higher SOI, a longer SO duration, a higher IOP before SO removal and a longer AL than those without (all P < 0.05).ConclusionsPatients with a larger AL and higher IOP before SO removal were more prone to have more residual SO droplets, which might in turn lead to an elevated IOP. In these eyes, thorough irrigation or repeated fluid-air exchange might be necessary.

Information available on consumer-facing websites may affect adherence to important public health measures such as reducing sodium consumption.

Information available on consumer-facing websites may affect adherence to important public health measures such as reducing sodium consumption.

Circulating Plasma Concentrations of ACE2 in Primary Aldosteronism and Cardiovascular Outcomes.

ContextThe plasma concentrations of angiotensin-converting enzyme 2 ([pACE2) has been independently associated with cardiovascular diseases.ObjectiveHigher [pACE2] concentrations could be found in patients with primary aldosteronism (PA) and might lead to increased cardiovascular events.MethodsUsing an inception observational cohort, we examined [pACE2] among 168 incident patients with PA. The expression of ACE2, serine protease 2 (TMPRSS2), and metalloprotease 17 (ADAM17) were assessed in peripheral blood mononuclear cells (PBMCs).ResultsIncident PA and EH patients had similarly elevated [pACE2] (47.04 ± 22.06 vs. 46.73 ± 21.06 ng/ml, p= 0.937). Age was negatively (β, -2.15, p= 0.033) and higher serum potassium level (β, 2.29, p= 0.024) was positively correlated with higher [pACE2] in PA patients. Clinical complete hypertension-remission after adrenalectomy (PASO criteria) was achieved in 36 (50%) of the 72 surgically-treated uPA patients. At follow-up, the [pACE2] decreased in surgically-treated patients who had (p< 0.001) or had no (p= 0.006) hypertension-remission, but the [pACE2] attenuation was not significant in uPA (p= 0.085) and biPA (p= 0.409) administered with minerocorticoid receptor antagonist (MRA). Persistently elevated [pACE2] (> 23ng/ml) after targeted treatments was related to all-cause mortality and cardiovascular events among PA patients (HR, 8.8, p = 0.04); with a mean followed up of 3.29 years. TMPRSS2 mRNA expression was higher in uPA (p= 0.018) and EH (p= 0.038) patients than that in normotensive controls; it was also decreased after adrenalectomy (p< 0.001).ConclusionsPA and EH patients had elevated [pACE2] and higher expression of TMPRSS2 mRNA compared to those of normotensive population. Persistently elevated [pACE2] (> 23ng/ml) after targeted treatments was associated the risk of mortality and incident cardiovascular events.

Abstract P018: A Little Goes A Long Way: Improving Blood Pressure Control Through A Loaner BP Cuff Program

Introduction: Out-of-office blood pressure (BP) measurement is key to diagnosing and improving hypertension (HTN). Effective out-of-office BP measurements depend on owning a home BP device. By loaning BP cuffs to patients with HTN, we aimed to improve rates of BP control at our residency clinic by 10% in 12 months. Methods: Root Cause Analysis identified barriers to out-of-office BP testing. BP cuffs obtained via a QI grant were loaned to patients through our Hypertension Clinic. We also provided education on proper technique, lifestyle, and medication management. Patients were referred by residents and attendings, or recruited via telephone outreach targeting those with BP &gt; 160 mmHg. Patients of the HTN clinic served as our experimental cohort. Workflows and outreach were revised via PDSA cycles. Resident engagement was assessed by survey. Results: In our experimental cohort, BP control for severe hypertension (&lt;160 mmHg) improved from 76% to 84% and overall BP control (&lt; 140 mmHg) from 47% to 54% at 5 months. For the whole clinic, BP control for severe hypertension improved from 85% to 91% at 1 month and 87% at 5 months; overall blood pressure control decreased from 75% to 67%. Surveyed residents reported regular follow up, medication titration and getting a BP cuff loaner as top reasons for referral. Conclusions: We successfully implemented a BP cuff loaner program within a hypertension clinic. Initial data shows improvement of severe and overall BP control for enrolled patients. The program was well-received by involved providers and patients. Providing BP cuff loaners is an effective low-cost intervention that improved BP control and decreases disparity for low-income patients.

Feasibility and efficacy of a nurse practitioner-and pharmacist-led hypertension clinic.

Hypertension (HTN) affects over one third of adults in the United States. Blood pressure (BP) management and patient education are provided by physicians, advanced practice clinicians, pharmacists, and nurses. In the traditional medical/clinic model, physicians have provided and directed HTN care. However, advanced practice nurses and pharmacists are also well trained and positioned to manage HTN. The purpose of this study was to explore the feasibility of an HTN clinic, led by a nurse practitioner (NP) and PharmD, specifically analyzing if targeted HTN can be achieved in this setting. Registry data were used to analyze the initial and the most recent visit BP levels in patients who were seen in an NP/PharmD-led HTN clinic. Measures of central tendency and differences between initial and most recent visit were also compared. A total of 46 patients were included in this analysis. Data showed that there was no statistically significant difference in the first visit (144/86) and the most recent visit (138/84) BP ( p = .26), but that there was a clinical trend in decreasing BP as well as narrowing of BP ranges and interquartile ranges between visit. The NP/PharmD-led clinic is feasible and can help lower BP and narrow ranges toward targeted BP.

Abstract P089: Health Facility Readiness For Hypertension Management In Ghana, West Africa

Background: Hypertension continues to be a growing health burden in Sub-Saharan Africa (SSA). The health systems in SSA are ill-equipped to manage patients with hypertension. The current study explored hypertension service readiness at the health facilities in Kumasi, Ghana. Methods: We purposively recruited 11 (out of over 200) health facilities that provide hypertension services in Kumasi, Ghana. At each facility, we administered the Hypertension Service Availability and Readiness tool. The main outcome of interest was hypertension service readiness regarding the availability of hypertension guidelines, provider and their training, equipment, diagnostics, and anti-hypertensive medications. We used descriptive analysis and reported counts (%) and median (Interquartile Range). Results: Five facilities (46%) were of medium size with 50-100 bed-capacity, four (36%) were government-owned, five (46%) treated patients with hypertension in a hypertension clinic while the rest managed them in the general outpatient department (Table). At least one provider had received cardiovascular disease training at 7 (64%) facilities. Hypertension-related patient education materials and treatment guidelines were available in 6 (54%) and 8 (72%) facilities, respectively. Also, 7 (64%) had all of the first-line anti-hypertensive medications (as stipulated in Ghana Standard Treatment Guidelines) available. Conclusion: We identified gaps in provider training, patient education, and first-line medication availability related to hypertension in Ghana. This study calls for policy changes to improve hypertension management and prevention of cardiovascular diseases.

Abstract P243: Innovative Care Team Design: An Original Approach To Optimize Patient Outcomes With Our RN-pharmacist Led Hypertension Clinic

Background: Bozeman Health (BH) Primary Care provides care to &gt;8000 patients with a diagnosis of hypertension (HTN). In 2019, less than half of these patients had their blood pressure (BP) controlled. The State of Montana Board of Pharmacy grants pharmacists the ability to have collaborative practice agreement(s) with providers. This allows the pharmacist to act as an intermediary to the provider and a ‘safety net’ for the nurses working off protocol. Utilizing evidence-based medication protocols, registered nurses (RNs) with clinical pharmacy collaboration, began treating HTN patients utilizing motivational interviewing, shared decision making, lifestyle modification, risk assessment tools, medication titration and regular follow-up. The program is initiated with a primary care provider (PCP) referral. Methods: The RN-Pharmacist led HTN Clinic was implemented in January 2019 after a 3-month pilot program which showed 90% (35 of 39) of enrolled patients achieved BP goal within 9 weeks or less. Ambulatory care RNs completed a 12-week intensive educational program on HTN. Upon completion of education, RNs managed patient appointments (including telemedicine appointments), charted and worked off medication protocol algorithms. Office notes were sent to the pharmacist to sign prescriptions and subsequently to the PCP for general information. Patients were seen in follow-up every 2-4 weeks with the HTN RN until their BP and personal goals were met. The primary objective of this project was to have 75% of patients referred to the hypertension clinic at goal within 12 weeks. Secondary outcomes included: secondary cause risk assessment, decrease in BMI, and high patient satisfaction scores. Results to date: •Enrolled 607 patients, 74% (237 of 321) at BP goal within 12 weeks •Average decrease in systolic BP - 8.4mmHg and diastolic BP - 5.5mmHg •Net decrease of 0.12kg/m2 in BMI upon graduation •Patient program satisfaction surveys 4.8/5; 5 being “very satisfied” Conclusions: The RN-Pharmacist Led HTN Clinic is an innovative, collaborative, multidisciplinary approach to hypertension management that allows care team members to practice at the top of licensure while improving HTN outcomes and achieving high patient satisfaction.

Abstract P213: Bridging The Gap In Hypertension Outcomes In Rural United States: A 6-month Report From A Pharmacist-run Hypertension Clinic In An Appalachian University Teaching Hospital

Background: Hypertension (HTN) constitutes a significant risk factor for cardiovascular diseases, including stroke and myocardial infarction. According to CDC, HTN rate is 10% higher in rural areas than in most urban areas. Rural Appalachia has even higher HTN rates (&gt;10% above the national rate). Optimization of rural health care is critical in improving overall outcomes of HTN. We, thus, compared a 6-month trend in BP control pre and post-referral of patients to a pharmacist-led BP clinic. Methods: This was a prospective study carried out in the HTN clinic of an Appalachian teaching hospital. The analysis was restricted to hypertensive patients aged ≥18 years. Interventions included medication management and health promotion. Average and upper limits of BP and the number of office visits in both periods were collected. Paired T-test was used for analysis. A p-value &lt;0.05 is considered to be statistically significant. Results: Of the 51 persons analyzed, 38 were eligible for inclusion. The average systolic BP demonstrated a significant decline from 160s to 140s mm Hg (p-value &lt;0.0001; 95% confidence interval -27.83 to -14.75; SEM 3.228). DBP showed a drop from around 85 to 80 mm Hg (p-value 0.0039; 95% CI -9.683 to -2.002; SEM of 1.895). The upper limits of SBP before and after referral also reached statistical significance (p-value 0.0008; CI -24.43 to -6.976; SEM 4.303). The BMI did not reach statistical significance. Patients visited the clinic almost twice as much after referral within the 6-month period that was studied (1.27 vs 2.29). Conclusions: Overall, pharmacist-led BP control may potentially play a huge role in improving the outcomes of HTN in resource-limited, rural areas.

Abstract P010: Performance Of Home Blood Pressure Monitors In The Clinical Setting

Background: Self-measured blood pressure (SMBP) monitoring is increasingly used for remote management of hypertension, but the real-world performance of home BP devices remains unsettled. Objectives: To determine the performance of home BP devices among patients with hypertension using the American Medical Association’s (AMA) Self-Measured Blood Pressure Device Accuracy Test protocol. Methods: Patients at a single hypertension clinic underwent up to five seated, same-arm BP readings using home monitors and an automated BP machine (Omron HEM-907XL). Following the AMA’s 3-step protocol, we used the home device for the first, second, and fourth measures and the office device for the third and fifth (if needed) measures. Device failure was defined as an absolute difference in systolic BP &gt;10 mm Hg between the home and office monitors in either Step 2 or Step 3. Patient factors associated with failure were examined via logistic regression models adjusted for age, sex, and race. Results: We evaluated 152 patients (mean age 60 ± 15 years, 58% women, 31% Black) seen between October 2020 and November 2021. Device failure occurred in 21.7% (95% CI: 15.8, 29.0) of devices tested, including 18.1% among Omron devices and 27.6% among non-Omron devices ( P = 0.08) ( Table ). Higher BMI was associated with higher odds of device failure (OR: 1.09; 95% CI: 1.01, 1.17) though age, sex, and race were not associated with device failure. Conclusions: Over one-fifth of home devices failed accuracy testing using the AMA SMBP protocol. Higher BMI was associated with device failure. These findings confirm the importance of office-based monitor verification to ensure the accuracy of home BP monitoring.

Polycystic Ovary Syndrome: Insights from Preclinical Research.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting approximately 10%. PCOS is diagnosed by the presence of at least two of these three criteria: hyperandrogenemia, oligo- or anovulation, and polycystic ovaries. The most common type (80%) of PCOS includes hyperandrogenemia. PCOS is also characterized by obesity or overweight (in 80% of US women with PCOS), insulin resistance with elevated plasma insulin but not necessarily hyperglycemia, dyslipidemia, proteinuria, and elevated BP. Although elevated compared with age-matched controls, BP may not reach levels considered treatable according to the current clinical hypertension guidelines. However, it is well known that elevated BP, even modestly so, increases the risk of cardiovascular disease. We have developed a model of hyperandrogenemia in rodents that mimics the characteristics of PCOS in women, with increases in body weight, insulin resistance, dyslipidemia, andproteinuria and elevated BP. This review discusses potential mechanisms responsible for the elevated BP in the adult and aging PCOS rat model that may be extrapolated to women with PCOS.

Understanding barriers and facilitators to clinic attendance and medication adherence among adults with hypertensive urgency in Tanzania.

Hypertensive urgency is a major risk factor for cardiovascular events and premature deaths. Lack of medication adherence is associated with poor health outcomes among patients with hypertensive urgency in resource-limited settings. To inform the development of tailored interventions to improve health outcomes in this population, this study aimed at understanding facilitators and barriers to clinic attendance and medication adherence among Tanzanian adults with hypertensive urgency. We conducted in-depth interviews with 38 purposively selected participants from three groups: 1) patients with hypertension attending hypertension clinic, 2) patients with hypertension not attending hypertension clinic, and 3) clinic health workers. Interviews were conducted using a semi-structured guide which included open-ended questions with prompts to encourage detailed responses. In their narrative, patients and healthcare workers discussed 21 types of barriers/facilitators to clinic attendance and medication adherence: 12 common to both behaviors (traditional medicine, knowledge and awareness, stigma, social support, insurance, reminder cues, symptoms, self-efficacy, peer support, specialized care, social services, religious beliefs); 6 distinct to clinic attendance (transport, clinic location, appointment, patient-provider interaction, service fragmentation, quality of care); and 3 distinct to medication adherence (drug stock, side effects, medicine beliefs). The majority of identified barriers/facilitators overlap between clinic attendance and medication adherence. The identified barriers may be surmountable using tailored supportive intervention approaches, such as peer counselors, to help patients overcome social challenges of clinic attendance and medication adherence.

To assess the prevalence of clinical and subclinical cardiac autonomic dysfunction in adolescent with family history of hypertension and adolescent with prehypertension; correlating with adolescent anthropometric parameters

Objectives: Hypertension (HTN) is an inherited disorder and these patients manifest with cardiac autonomic dysfunction (CAD). The present study intends to assess the presence of pre HTN, clinical and subclinical CAD in adolescents with a family history of HTN, and to obtain its correlation with anthropometric values. Materials and Methods: After obtaining ethical clearance and informed consent, three groups containing 50 subjects each, of age 17–19 years were included in the study. (Group-I: Normotensives without a family history of HTN; Group-II: Normotensives with a family history of HTN and Group-III: prehypertensives). CAD was done by performing (1) resting tachycardia, (2) loss of sinus arrhythmia, and (3) heart rate response to the Valsalva manoeuvre. If any two of them are positive then the presence of CAD was confirmed. Results: Height, weight, BMI, SBP and DBP was significantly higher in group 3 (prehypertensives). Confirmed CAD findings was seen in 36% of group 2 and 46% of group 3 participants. Of the anthropometric parameters, a significant positive correlation was seen between weight and SBP, DBP and CAD parameters, and height with SBP and DBP. Conclusion: Clinical and subclinical CAD exists in adolescents with risk factors for HTN including heredity, obesity, and pre-HTN values. These risk factors show multiplicative effects for disease genesis and indicate high sympathetic and low parasympathetic drives. Extra care should be taken to curb the onset of clinical HTN and CAD in these young adults. Additional work needs to be done on pathophysiological mechanisms for the same.

New study suggests taking pressure off inpatient hypertension management

Researchers of a recently published retrospective cohort analysis published in the February 2022 issue of The Journal of Clinical Hypertension looked at hypertensive urgency patients at several teaching hospitals within their health system. Perhaps surprisingly, their results suggest that treatment of end organ damage (i.e., hypertensive urgency)—when developed during an admission—in addition to intravenous antihypertensive medication may be more deleterious than oral antihypertensive medication or no treatment at all.

Investigating medication adherence and illness perception among patients with hypertension in Al-Nasiriyah Teaching Hospital in 2022

Hypertension is one of the most common worldwide health problems, medication adherence is a major public health concern and leads to considerable morbidity, mortality, and healthcare costs. Hence, it is considering a serious challenge for the patients as well as for caregivers. The main objective of this study was to an Investigating Medication Adherence and Illness Perception Among Patients with Hypertension in Al-Nasiriyah Teaching Hospital. A quantitative descriptive cross-sectional design was performed among 424 adult hypertensive patients attending hypertension clinics in Al-Nasiriyah Teaching Hospital in Al-Nasiriyah, southern Iraq. The data were collected over a period of three months from April 6th, 2022, to July 1st, 2022, by using a questionnaire includes three parts, related to Socio- Demographic and clinical data, eight item-Morisky Medication Adherence Scale (8-MMAS), and Brief illness perception questionnaire (BIPQ). Data was analysis by using SPSS version 25, descriptive statistics (percentage, frequency, SD, mean) used to describe socio-demographic data, Inferential statistics (chi- square test) was used to assess the association between illness perception and treatment adherence, and Anova used to find the relationship between overall evaluation of (BIPQ), eight item 8-MMAS and Demographical data.

Long-term oxygen therapy in COPD: what is the evidence?

Thomas L Petty was the founder of modern long-term oxygen therapy (LTOT).1 In 1967, Petty's group published the seminal study of six patients with severe chronic airway obstruction, in whom LTOT improved clinical status, exercise capacity, secondary erythrocythemia, and pulmonary hypertension.2 Notably, all patients had severe hypoxaemia (partial pressure of oxygen [PaO2] 41·5–46·5 mm Hg) and four patients were severely hypercapnic (partial pressure of carbon dioxide [PaCO2] 55·0–61·5 mm Hg). Thereafter, two randomised controlled trials that were initiated in the 1970s established a clear survival benefit related to LTOT in patients with chronic obstructive pulmonary disease (COPD) with severe resting hypoxaemia: the Nocturnal Oxygen Therapy Trial (NOTT)3 and the British Medical Research Council (BMRC) trial.

Association Between Sleep Microstructure and Incident Hypertension in a Population-Based Sample: The HypnoLaus Study.

Background Poor sleep quality is associated with increased incident hypertension. However, few studies have investigated the impact of objective sleep structure parameters on hypertension. This study investigated the association between sleep macrostructural and microstructural parameters and incident hypertension in a middle- to older-aged sample. Methods and Results Participants from the HypnoLaus population-based cohort without hypertension at baseline were included. Participants had at-home polysomnography at baseline, allowing assessment of sleep macrostructure (nonrapid eye movement sleep stages 1, 2, and 3; rapid eye movement sleep stages; and total sleep time) and microstructure including power spectral density of electroencephalogram in nonrapid eye movement sleep and spindles characteristics (density, duration, frequency, amplitude) in nonrapid eye movement sleep stage 2. Associations between sleep macrostructure and microstructure parameters at baseline and incident clinical hypertension over a mean follow-up of 5.2years were assessed with multiple-adjusted logistic regression. A total of 1172 participants (42% men; age 55±10years) were included. Of these, 198 (17%) developed hypertension. After adjustment for confounders, no sleep macrostructure features were associated with incident hypertension. However, low absolute delta and sigma power were significantly associated with incident hypertension where participants in the lowest quartile of delta and sigma had a 1.69-fold (95% CI, 1.00-2.89) and 1.72-fold (95% CI, 1.05-2.82) increased risk of incident hypertension, respectively, versus those in the highest quartile. Lower spindle density (odds ratio, 0.87; 95% CI, 0.76-0.99) and amplitude (odds ratio, 0.98; 95% CI, 0.95-1.00) were also associated with higher incident hypertension. Conclusions Sleep microstructure is associated with incident hypertension. Slow-wave activity and sleep spindles, 2 hallmarks of objective sleep continuity and quality, were inversely and consistently associated with incident hypertension. This supports the protective role of sleep continuity in the development of hypertension.

PH Roundtable: Tailoring CTEPH Imaging for Evaluation and Postintervention Assessment—What Works and What’s New?

PH Roundtable: Tailoring CTEPH Imaging for Evaluation and Postintervention Assessment—What Works and What’s New?

Nasal and Parotid Blood Pool Activity Is Significantly Correlated with Metabolic Syndrome Components and Sleep Apnea.

Background: Patients with metabolic syndrome components were frequently noted to have increased nasal and parotid activity on clinically referred scintigraphic whole-body blood pool scans. This increase in activity was not observed in patients without metabolic syndrome. Increased nasal blood pool activity in patients with elevated body mass indices (BMIs) has implications for (1) sleep apnea, (2) risk of nasal infection, and (3) possible impaired nasal lymphatic drainage of brain waste proteins. Methods: To follow-up this clinical observation, a retrospective study was performed on 200 patients having whole-body blood pool scans referred over a 3-year period. The whole-body blood pool scans were evaluated for an association between nose and parotid region of interest (ROI) to heart ROI maximum (max) pixel ratios as correlated with clinical conditions, including obesity, diabetes, hypertension, and sleep apnea. Continuous variables of BMI, hemoglobin A1c (HbA1c), blood glucose, and blood lipids were also correlated with these ratios. Results: A direct association of nose to heart max ratio (NHMR) with diabetes, sleep apnea, and hypertension was found with an increase in the ratio of +0.10 (P = 0.002), +0.13 (P = 0.0002), +0.08 (P = 0.0123), respectively. Correlation of NHMR with continuous variables had moderate correlation with BMI (r = 0.36, P < 0.0001), glucose (r = 0.27, P = 0.0001), HbA1c (r = 0.25, P = 0.0008) and less association with the number of diabetes medications (r = 0.22, P = 0.0021). Similar associations were found for parotid to heart max ratios but were weaker than the NHMR. Conclusions: Patients with metabolic syndrome components have significantly increased nasal and parotid activity on blood pool scans. These associations have implications for the treatment of sleep apnea, for nasal infections involving such agents as Covid-19, and for the risk of dementias related to decreased clearance of brain waste proteins through nasal turbinate lymphatics in patients with metabolic syndrome. If further studies support these findings, the nasal turbinates and the increased parasympathetic activity controlling their dilation could become a new therapeutic target.